EAQ- Lewis Med Surg CH.29, Nursing Management: Obstructive Pulmonary Diseases: Chronic Obstructive Pulmonary Disease

A patient in the outpatient clinic has symptoms including chronic cough, sputum production, and dyspnea. On taking a detailed history of the patient, the nurse finds that this patient has a prolonged exposure to smoke. Which condition would the nurse most likely suspect the patient to have? 1. Chronic obstructive pulmonary disease (COPD) 2. Tuberculosis 3. Pneumonia 4. Influenza

1. Chronic obstructive pulmonary disease (COPD) COPD symptoms include cough, sputum production, and dyspnea. In addition, this patient has a history of exposure to allergens such as smoke. Tuberculosis is a bacterial infection with a low-grade fever and weight loss. Dyspnea is a late symptom of tuberculosis. Pneumonia is an infection with a cough, dyspnea, fever, chills, and pleuritic chest pain. Influenza is a viral infection with sneezing, watery eyes and nose, and fever.

What complication does the nurse expect in a child with chronic pulmonary disease who is diagnosed with α1-antitrypsin (AAT) deficiency? 1. Liver disease 2. Renal disease 3. Intestinal dysfunction 4. Urinary tract dysfunction

1. Liver disease AAT deficiency is an autosomal recessive disorder associated with mutations in the SERPINA1 gene, S and Z alleles. These mutations result in abnormalities of the lungs and liver. The mutation in the SERPINA1 gene does not affect the functions of the kidneys, intestine, or urinary tract.

Which complication does the nurse monitor in the patient who is using an oxygen-conserving cannula? 1. Necrosis over tops of ears 2. Loss of oxygen into the atmosphere 3. Tissue damage at the tracheostomy tube 4. Decrease in fraction of inspired oxygen levels

1. Necrosis over tops of ears The oxygen-conserving cannula is applied as a moustache or pendant type, over the ears. The patient may experience necrosis over the tops of the ears due to constant contact. The oxygen-conserving cannula has pipes placed directly over the naris, so the loss of oxygen into atmosphere is very little. A patient who is using a tracheostomy collar will have tissue damage at the tracheostomy tube. While using non-rebreather masks, a decrease in the fraction of inspired oxygen, or FIO2, may occur.

When should a nurse schedule postural drainage for a patient who has chronic obstructive pulmonary disease (COPD)? 1. One hour before a meal 2. Immediately after meals 3. After providing juice to the patient 4. After administering nasal medications

1. One hour before a meal Postural drainage is performed one hour before meals to avoid nausea and vomiting. The procedure can also be performed three hours after meals but not immediately after meals, to avoid nausea and vomiting. Even if only juice is provided to the patient before postural drainage, the patient may feel nausea. Nasal medications may be excreted during the drainage if postural drainage is performed after administering nasal medications.

Prolonged exposure to a high level of oxygen leads to pulmonary damage caused by: 1. Oxygen toxicity 2. Normoxia 3. Anoxia 4. Hypoxia

1. Oxygen toxicity Pulmonary O2 toxicity may result from prolonged exposure to a high level of O2 (PaO2). High concentrations of oxygen can result in a severe inflammatory response because of oxygen radicals and damage to alveolar-capillary membranes resulting in severe pulmonary edema, shunting of blood, and hypoxemia. These individuals develop acute respiratory distress syndrome (ARDS). Normoxia is not a condition of having too much oxygen, but a normal amount. Anoxia and hypoxia are conditions of having too little oxygen, not too much.

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? 1. An overproduction of the antiprotease a1 antitrypsin 2. Hyperinflation of alveoli and destruction of alveolar walls 3. Hypertrophy and hyperplasia of goblet cells in the bronchi 4. Collapse and hypoventilation of the terminal respiratory unit

2. Hyperinflation of alveoli and destruction of alveolar walls In COPD there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antiproteaste α1-antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells.

The nurse is caring for a patient diagnosed with cor pulmonale. What symptoms assessed by the nurse correlate with the assigned diagnosis? 1. Oxygen saturation of 92% 2. Presence of edema in the ankles 3. Yellowish discoloration of the skin 4. Partial pressure of arterial oxygen (PaO2) is 60 mm Hg

2. Presence of edema in the ankles Cough, sputum production, and dyspnea indicate that the patient has chronic obstructive pulmonary disease (COPD). Cor pulmonale is the impairment or failure of the right side of the chest, which is characterized by the presence of edema in the ankles. The patient with cor pulmonale will have chronic hypoxia, so the oxygen saturation is less than 88%. The patient with chronic obstructive pulmonary disease (COPD) will have the bluish discoloration of skin associated with polycythemia. A yellowish discoloration is associated with jaundice. The PaO2 of the patient with COPD is less than 60 mm Hg due to severe hypoxemia. A PaO2 of 60 mm Hg is a normal finding.

The purpose of this exercise is to prolong exhalation and thereby prevent bronchiolar collapse and air trapping. 1. Diaphragmatic breathing 2. Pursed-lip breathing (PLB) 3. Huff coughing 4. Chest physiotherapy (CPT)

2. Pursed-lip breathing (PLB) The purpose of PLB is to prolong exhalation and thereby prevent bronchiolar collapse and air trapping. PLB is simple and easy to teach and learn, and it gives the patient more control over breathing, especially during exercise and periods of dyspnea. Another type of breathing retraining exercise is diaphragmatic breathing, which focuses on using the diaphragm to achieve maximum inhalation and slow respiratory rate, not prolong exhalation. Huff coughing is an effective forced expiratory technique, not a breathing exercise to prolong exhalation. Chest physiotherapy (CPT) consists of postural drainage, percussion, and vibration and is for patients who have difficulty clearing excessive bronchial secretions.

When teaching the patient with chronic obstructive pulmonary disease (COPD) about smoking cessation, what information should be included related to the effects of smoking on the lungs and the increased incidence of pulmonary infections? 1. Smoking causes a hoarse voice 2. Cough will become nonproductive 3. Decreased alveolar macrophage function 4. Sense of smell is decreased with smoking

3. Decreased alveolar macrophage function The damage to the lungs includes alveolar macrophage dysfunction that increases the incidence of infections and thus increases patient discomfort and cost to treat the infections. Other lung damage that contributes to infections includes cilia paralysis or destruction, increased mucus secretion, and bronchospasms that lead to sputum accumulation and increased cough. The patient may be aware already of respiratory mucosa damage with hoarseness and decreased sense of smell and taste, but these do not increase the incidence of pulmonary infection.

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? 1. Acute respiratory failure 2. Secondary respiratory infection 3. Fluid volume excess resulting from cor pulmonale 4. Pulmonary edema caused by left-sided heart failure

3. Fluid volume excess resulting from cor pulmonale Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

The nurse is educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes despite the diagnosis. What complication of smoking should the nurse discuss with the patient? 1. Cachexia 2. Osteoporosis 3. Metabolic syndrome 4. Cardiovascular disease

4. Cardiovascular disease Chronic smokers develop COPD and are more prone to cardiac complications, because smoking directly affects the function of the lungs and heart. The patient with COPD may experience a loss of appetite due to dyspnea, which may lead to the development of cachexia. Osteoporosis is a complication of COPD that is associated with continuous systemic inflammation. Dyspnea and a loss of appetite are associated with COPD and may manifest as a metabolic syndrome. Cachexia, osteoporosis, and metabolic syndrome are not associated with smoking.

A patient with emphysema is receiving oxygen at 1 L/min by way of nasal cannula. The nurse understands that this prescription is appropriate because: 1. The patient does not require more than 1 L of oxygen 2. High concentrations of oxygen may rupture the alveoli 3. Oxygen is the natural stimulus for breathing and not required 4. High concentrations of oxygen eliminate the respiratory drive

4. High concentrations of oxygen eliminate the respiratory drive Patients with emphysema become accustomed to a high level of carbon dioxide and low level of oxygen. This situation reverses the natural breathing stimulus. A low oxygen level then becomes the stimulus for breathing, and too much oxygen will eliminate the stimulus to breathe. There is not enough information to determine that the patient does not need more than 1 L of oxygen. A high concentrations of oxygen does not rupture alveoli. In healthy individuals, increased carbon dioxide, not oxygen, is the stimulus for breathing.

Which laboratory finding helped the nurse reach the conclusion that a patient with a chronic cough and dyspnea has hypercapnia? 1. Hemoglobin concentration is 14 g/dL. 2. Red blood cell count is 4.9 million cells/microliter. 3. Partial pressure of arterial oxygen (PaO2) is 75 mm Hg. 4. Partial pressure of carbon dioxide (PaCO2) is 55 mm Hg.

4. Partial pressure of carbon dioxide (PaCO2) is 55 mm Hg. The patient has a chronic cough and dyspnea, indicating that he or she has chronic obstructive pulmonary disease (COPD). The normal range of PaCO2 is 35 to 45 mm Hg. The PaCO2 of the patient is 55 mm Hg, which indicates hypercapnia. Normal hemoglobin levels are 13.5 to 17.5 g/dL. The patient has a hemoglobin concentration of 12 g/dL, which is a normal finding and does not indicate that the patient has any complication. The normal range for red blood cell count is 4.7 to 6.1 million cells/microliter. A patient with COPD may develop polycythemia but this patient has a normal red blood cell count of 4.9 million cells/µL. A PaO2 level of above 70 mm Hg indicates that the patient does not have hypoxemia. The partial pressure of arterial oxygen is 75 mm Hg, which is a normal finding.

Infection can be a major hazard of O2 administration. Heated nebulizers present the highest risk. The most common organism found is: 1. Rickettsia prowazekii 2. Clostridium perfringens 3. Bordatella pertussis 4. Pseudomonas aeruginosa

4. Pseudomonas aeruginosa The constant use of humidity supports bacterial growth, with the most common organism being P. aeruginosa. Rickettsia prowazekii, Clostridium perfringens, and Bordatella pertussis are not the most common organisms found in this case.